Radiographic Evaluation of the Symptomatic Total Hip Arthroplasty

A 50-year-old man underwent left total hip replacement to treat osteoarthritis. Because of his age and activity level, a large resurfacing socket was used to maximize stability and minimize wear ( Fig. 41.1 , A ). The patient presented 3 years later with continued discomfort localized in his hip. Radiographs demonstrated socket migration with evidence of a complete radiolucent line around the socket. The stem showed the hallmarks of bone ingrowth with reactive bone streaming into the implant and calcar round-off (see Fig. 41.1 , B ). A socket revision was performed with a porous metal socket and metal–polyethylene articulation. The patient underwent an uneventful recovery with resolution of his pain. At 1 year, there was good evidence of osseointegration of the new socket with absence of radiolucent lines and migration. Consolidation of the impaction allograft of the medial defect was still in progress (see Fig. 41.1 , C ).